Choosing Your Medical Specialty: Family Medicine

kurhan/123RF.com

Sometimes (most of the time?) a career path chooses its "owner," rather than the owner planning and executing the carefully laid out elements of a career.

When I was putting together a map for my specialty-to-be, family practice (renamed family medicine in 2005) came calling, literally. I had secured a coveted contract with an anesthesia residency, but the start date was two years in the future. It looked like I would be spending those two years in an internal medicine residency, after which I would qualify for board certification.

I tried to convince myself that would be a good thing. I just needed to have a good "talking to" with myself, a kind of attitude adjustment. The truth was that I was dreading every minute I'd be functioning (dysfunctioning – is that even a word?) as an internal medicine resident. To me, the whole content seemed obscure and overwhelming, as it always had. It was just cerebral exercise, with no discernable mind-muscle building. I felt helpless about memorizing such infinite and intangible minutia. I'd signed a contract, however, and was within days of starting life as an internal medicine resident.

Then came the call – from Ben, a friend made during internship. He was starting a family practice residency at a hospital consistently ranked among the top 100 hospitals in the nation by U.S. News and World Report. At the time they had only four positions per year. Only three 1^st year positions were filled; they needed a 4^th. Ben asked me to take a look at the unfilled position. The rest, as they say, is history.

My first year as a family practice resident started with a month of cardiology, an internal medicine field. Next, however, were two months of obstetrics which I really enjoyed. By the end of the two months I was ready to switch fields to obstetrics. I also enjoyed my next two months in pediatrics. Then came two months of surgery – which I loved.

One day the chair of the department of anesthesia in which I'd secured a residency called; he had my contract ready to sign. It was scary, but I let it go. I wanted to find out where family practice would lead. It did not disappoint.

Family medicine is the only specialty in which the physicians are qualified to treat virtually all ailments and all ages, and have the right to claim global competence. It's the specialty in greatest demand. A family medicine physician can practice almost anywhere - a population of 2000 can support a practice. Some specialties require a population of 10,000. Some subspecialties need a population of 50,000 to be viable. Family medicine offers the most, and the most diverse, opportunities, compared to other specialties. Research and work in academia, as faculty with a family medicine residency or an instructor with medical schools is rewarding – and you can change the face of healthcare. Administration is an option. Some family doctors choose positions in which there is no direct patient contact, such as development of new products in the pharmaceutical industry. Having a diverse knowledge base, family doctors are ideal for staffing emergency departments and urgent care centers. Locum tenens positions are plentiful, if the doctor likes travel and appreciates meeting new people and places. Moonlighting assignments are abundant.

Family doctors can choose a cause, or branch out into a special interest, such as: sports medicine, pediatrics, geriatrics, obstetrics, addiction medicine, occupational medicine, alternative and complementary medicine, public health, international and travel medicine, or a special interest of his/her own creation.

During a stint in Alaska, at a remote hospital accessible only by bush plane, I knew what to do when a frantic call came over the loudspeaker for a doctor, stat – an unexpected birth was happening. I caught the baby within moments of my arrival. An internist might have been at a loss for what action to take. I knew what to do at 30,000 feet in a commercial jet, when a flight attendant made a plea, "Is there a doctor on board?" A passenger had suddenly lost consciousness. We made it safely to our destination and the waiting ambulance. That just wouldn't work for a radiologist. I have an endless number of stories, and a richer experience as a family physician than I ever imagined (even with the internal medicine component). Sometimes it felt like my patients were ministering to me – with their gratitude and trust.

Another lesson from my experience – answer your phone calls. Thank goodness I did.